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Recent data from large trials of high-frequency high frequency oscillation (HFO) without a cuff leak vs, lung-protective conventional ventialtion (CMV) failed to show any HFO-related benefit with respect to outcome. A possible explanation is that HFO increases the probability of right ventricular dysfunction due to the combination of high mean airway pressures (mPaws) and hypercapnia. In contrast, available preliminary data on low-frequency HFO-tracheal gas insufflation (TGI) with cuff leak vs. CMV are suggestive of an HFO-TGI related benefit. Low-frequency HFO-TGI with a cuff leak is associated with relatively low mean tracheal pressures and adequate control of PaCO2. Thus, the investigators intend to test the hypothesis that low frequency HFO +/- TGI with a cuff leak is associated with better right ventricular function relative to high-frequency HFO without a cuff leak.

Further study details as provided by Spyros D. Mentzelopoulos, University of Athens:

Primary Outcome Measures:

Right ventricular diastolic area, left ventricular diastolic area as determined by transesophageal echocardiography during the application of the tested ventilatory strategies. [ Time Frame: Within 6-7 hours after study enrollment ]

Eccentricity index as determined by transesophageal echocardiography during the application of the tested ventilatory strategies [ Time Frame: Within 6-7 hours after study enrollment ]

Secondary Outcome Measures:

PaO2, PaCO2 and arterial pH during the application of the tested ventilatory strategies [ Time Frame: Within 6-7 hours after study enrollment ]

Mean arterial pressure during the application of the tested ventilatory strategies [ Time Frame: Within 6-7 hours after study enrollment ]

Cardiac index during the application of the tested ventilatory strategies [ Time Frame: Within 6-7 hours after study enrollment ]

Static Compliance of the Respiratory System before and after the application of the tested HFO strategies [ Time Frame: Within 6-7 hours after study enrollment ]

Other Outcome Measures:

Occurrence of hypoxemia during the early and intermediate phase of ARDS [ Time Frame: Within days 1-10 after study enrollment ]

Occurrence of in-hospital death and underlying cause(s) [ Time Frame: Within days 1-60 after study enrollment ]

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Ages Eligible for Study:

18 Years to 75 Years (Adult, Senior)

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

No

Criteria

Inclusion Criteria:

Acute Respiratory Distress Syndrome (ARDS) according to the Berlin Definition Onset of ARDS within the 72 hours preceding study enrollment PaO2/FiO2 of less than 150 mmHg while ventilated with a positive end-expiratory pressure of at least 10 cmH2O Body weight of more than 40 Kg Age 18-75 years